Provider Demographics
NPI:1649869066
Name:MAKHOBENG, SEIPATI SASHA
Entity type:Individual
Prefix:
First Name:SEIPATI
Middle Name:SASHA
Last Name:MAKHOBENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11891 AUTUMN SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-8009
Mailing Address - Country:US
Mailing Address - Phone:323-627-7814
Mailing Address - Fax:
Practice Address - Street 1:11891 AUTUMN SUNSET WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-8009
Practice Address - Country:US
Practice Address - Phone:323-627-7814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH484951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse